Association of child abuse and neglect training with filing reports of concern to child welfare services: a cross-sectional study.

BACKGROUND: The aptitude, knowledge, and competence of dental health personnel on child abuse and neglect (CAN) is not optimal for deciding when to file a report of concern to child welfare services (CWS). OBJECTIVES: The aim of this study was, firstly, to assess the association of the public dental health personnel 's (PDHP) training on CAN received in the last three work years, i.e., in 2016 through 2018 with filing reports to the CWS in the same period and secondly to assess the association of expressed need of training on CAN with filing reports to the CWS. METHODS: This cross-sectional study uses data from an electronic survey census of PDHP from Norway (n = 1791) conducted in 2019. The Pearson chi-square test, non-parametric tests, logistic, and negative binomial regression were used for unadjusted and adjusted analysis. Data was reported with proportions, odds ratios (OR), incidence rate ratios and 95% confidence intervals (CIs). RESULTS: From 2016 to 2018, the prevalence estimate of filing reports to CWS was 50%, with a mean (standard deviation) of 1.39 (2.11) reports sent. The logistic regression analysis showed an association between filing reports of concern and CAN training in the last three years. Compared to those that had not received CAN training during the three previous years, the ORs (95% CI) for filing reports to the CWS during the same period was 2.5 (1.6-4.0) for one day CAN work training, 3.2 (2.0-5.1) for 2-4 days CAN training and 4.9 (2.6-9.4) for five or more days CAN training. Compared to workers who did not need training in reporting (routines of CAN), those who expressed the need for a little more and more training were less likely to file a report. The corresponding OR were 0.6 (0.4-0.9) and 0.6 (0.3-0.9), respectively. CONCLUSION: CAN training during the last three years is associated with filing reports of concern to CWS in the same period among PDHP in Norway. The likelihood of filing CAN reports increased with the number of days of CAN training received. Secondly, the PDHP with an expressed need for training on CAN routines were less likely to report suspicions to CWS.

Use of dental care services among adolescents living with HIV on Antiretroviral Treatment in Kampala, Uganda: a cross-sectional study.

Objective: The main purpose of this study to assess the prevalence and socio-behavioural determinants of ever-use of dental care services among the adolescents aged 10-18 years, living with HIV on Antiretroviral treatment (ART), attending selected HIV clinics in Kampala, Uganda. Methods: A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10-18 years from 4 specific HIV clinics in Kampala. The Andersen's behavioral model guided the selection of variables in terms of ever use of dental care services as the outcome- and predisposing, enabling, need related factors and dental health related behavior as exposure variables. Data was analyzed using Fischer's exact test for cross-tabulation and modified Poisson regression for multivariate analysis. Results: The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14-18 years were more likely to have used dental care services (Prevalence ratio (PR) of 3.35 (Confidence Interval (CI) 1.48-7.59) than those aged 10-13 years. Fear of spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06 and CI of (0.01-0.44). Participants who were afraid of going to the dentist were more likely to have ever used dental care services (PR of 2.98 and CI of 1.41-6.30) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with ever-use of dental care services (PR of 4.50 (CI: 1.14-17.80). Those who were satisfied with their dental condition were less likely to have ever-used dental care services (PR of 0.21 and CI of (0.05-0.94). Bad oral odor was positively associated with ever-use of dental care services with a PR of 2.80 and CI of 1.19-6.60. Use of soap for toothbrushing was positively associated with ever-use of dental care services (PR of 2.51, CI of 1.47-4.28). Conclusion: The study found low frequency of dental care use among HIV infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, dental appointment failure, and satisfaction with dental condition and bad oral odor while under personal oral hygiene and dental practices, use of soap for toothbrushing was an important association of use of dental care.

Information sharing between the dental healthcare and child welfare services regarding child maltreatment-A repeated cross-sectional study in Norway.

BACKGROUND: Little is known about dental healthcare workers reported suspected child maltreatment to and received inquiry from the child welfare services (CWS). AIM: Assess time lag differences in public dental healthcare workers' information sharing with CWS and identify sociodemographic and attitudinal covariates of information sharing with CWS in 2014 and 2019. DESIGN: In 2014 and 2019, a national census of 1542 and 1791 Norwegian dental health care workers, respectively, were invited to participate in an electronic survey. Of them, 1200 (77.8%) and 1270 (70.9%) replied to the questionnaires. Time trends of reported child maltreatment and received inquiries were estimated and adjusted for sociodemographics, attitudes, trust, and collaborative routines in logistic regression analyses. RESULTS: The likelihood of reported child maltreatment to and received inquiry from CWS was higher in 2019 than in 2014 (OR 1.4 [95% CI 1.2-1.7] and OR 1.1 [95% CI 0.9-1.4]). Significant associations occurred with sociodemographic characteristics, attitudes, and collaborative routines. The likelihood of receiving inquiry about whether being employed long versus short term was higher in 2019 than in 2014. CONCLUSION: Information sharing between dental healthcare workers and CWS improved across time and might promote beneficial outcomes.

Oral health inequalities in Swedish older adults over 25 years of follow-up.

OBJECTIVES: The aim of this study was to describe inequalities in tooth loss and dissatisfaction with teeth related to time-invariant and time-variant socio-demographic characteristics and use of dental care across the middle and older life course and to assess whether oral health inequalities remain stable, widen or narrow from age 50 to 75. MATERIALS AND METHODS: In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study including postal questionnaire follow-ups every fifth year until age 75. Tooth loss and dissatisfaction with teeth were assessed at each survey wave in addition to socio-demographic factors and use of dental care. Multivariable logistic regression, generalised estimating equations, GEE, and random intercept logistic mixed models were used for estimation of population-averaged and person-specific odds ratio. Interaction terms of each covariate with the time indicator were added to test whether inequalities changed across time. RESULTS: Person-specific OR and 95% CI estimates for tooth loss varied from 1.29 (1.09-1.53) (unmarried vs married) to 9.20 (6.07-13.94) (foreign country vs native). Estimated ORs for tooth dissatisfaction ranged from 1.33 (1.15-1.55) (unmarried vs married) to 2.59 (2.15-3.11) (smoking vs no smoking). Inequalities in tooth loss according to sex, educational level and country of birth were smaller in magnitude in 2017 than in 1992. Inequality estimates in dissatisfaction with teeth according to use of dental care and perceived health were, respectively, smaller and greater at older than at younger age. CONCLUSION: Socio-demographic inequalities in oral health persisted from age 50 to 75 and varied in magnitude across time. Both convergence and widening of disparities in oral health occurred towards older ages.

Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis.

OBJECTIVE: To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. MATERIAL AND METHODS: In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10-16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. RESULTS: 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 - 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 - 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. CONCLUSIONS: Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Association between oral and general health related quality of life among Norwegian patients with substance use disorders in opioid agonist therapy.

OBJECTIVE: Assess the association between oral and general health related quality of life using oral impacts on daily performances (OIDP) and the quality of life tool EQ-5D-5L from EuroQoL among patients with substance use disorder (SUD) who receive opioid agonist therapy. METHOD: 609 patients with SUD completed the EQ-5D-5L. A dental sub-study of 167 patients completed OIDP and an oral examination when attending outpatient clinics in Western Norway for their opioid agonist therapy. The merged analytical sample consisted of 165 patients. The association between OIDP and EQ-5D-5L was assessed by Spearman's rho and a linear multiple variable regression analysis. A line graph and a Pen's parade displayed the distributions of OIDP sum scores and EQ-5D-5L index values. RESULTS: Overall mean summary- and index EQ-5D-5L scores were 9.97 (sd 3.25) and 0.69 (sd 0.22). Mean score for OIDP was 9.75 (sd 9.59). Spearman's rho was 0.34 (p < .01) between OIDP and EQ-5D-5L summary scores. Linear regression revealed an association adjusted for sex and age of 0.12 (95% CI 0.07-0.17) and a coefficient of determination of 0.1460. CONCLUSION: This study reveals a strong association between OIDP and EQ-5D-5L reflecting the importance of oral health to general health for patients with SUD. Health care professionals should pay attention to oral health. Effective interventions might improve patients' oral and health related quality of life.

The dentist-patient relationship and oral health-related quality of life among older adults: A cohort study.

OBJECTIVES: To assess the association between aspects of the dentist-patient relationship at age 65 and Oral Impacts on Daily Performances (OIDP) at ages 65 and 70 and to examine whether dental avoidance behaviours play a role in explaining that association. BACKGROUND: Information about the quality of the dentist-patient relationship is important for dental care provision and healthy ageing. METHOD: Secondary data analysis of a cohort study of Norwegians born in 1942. The participation rate in 2007 (age 65) and 2012 (age 70) was, respectively, 58.0% (n = 4211) and 54.5% (n = 3733). A total of 70.0% (n = 2947) of the baseline participants responded in 2012. Dentist-patient relationship aspects were assessed in terms of communication with the dentist, satisfaction with dental care, unpleasant experiences and changes of dentist. Generalised Estimating Equations (GEEs) were used to account for repeated measurements. RESULTS: Prevalence of oral impacts (OIDP) was 29.0% in 2007 and 28.4% in 2012. Participants who received communication on oral hygiene during dental visits had a higher likelihood, whereas participants who reported satisfaction with dental care, no unpleasant experience and did not change dentist had a lower likelihood of reporting oral impacts over these 5 years. Corresponding odds ratios were: 1.2 (95% CI 1.0-1.5), 0.4 (95% CI 0.3-0.5), 0.6 (95% CI 0.5-0.7) and 0.5 (95% CI 0.3-0.6). Associations between dentist-patient relationship aspects and OIDP remained unchanged after adjustment for avoidance behaviours. CONCLUSION: Training dentists in relationship skills might improve social interaction with patients and the oral health-related quality of life of older people in Norway.

Role of behavioural and age-related factors in the long-term impact of tooth loss on oral health-related quality of life: A 25-year follow-up of Swedish older adults.

OBJECTIVES: The primary aim of this study was to assess any long-term association between tooth loss at age 50 and subsequent impaired oral health-related quality of life, OHRQoL, at age 65, 70 and 75, adjusted for time invariant socio-demographic-and time variant behavioural and age-related factors in terms of disadvantages with functional, social, health and psychological concerns. As a second aim, this study examined whether behavioural- and age-related factors played a role in explaining any long-term association between early tooth loss and subsequent OHRQoL. METHODS: In 1992, 6346 residents, aged 50, consented to participate in a prospective cohort study and 3060 completed postal questionnaire follow-ups every fifth year (six in total) until 2017. Information on tooth loss was assessed at baseline at age 50. Behavioural- and age-related covariates were assessed repeatedly at ages 65, 70 and 75. OHRQoL was the repeated outcome measure assessed by the Oral Impact on Daily Performance, OIDP at age 65, 70 and 75. Generalized Estimating Equations, GEE, with binomial logit function was used to test the association between tooth loss and prevalence of oral impacts (OIDP) adjusting for counfounders and potential mediators. The role of behavioural and age-related factors in explaining the association between early tooth loss and OHRQoL was tested using the change in estimate approach. RESULTS: Tooth loss and time variant behavioural- and age-related covariates associated independently with higher odds of impaired OHRQoL across time. The long-term impact of tooth loss seemed to be partly explained by time variant covariates related to functional and psychological concerns. Participants who had excessive tooth loss at age 50 were 2.5 times more likely to experience oral impacts before adjustment of covariates. After adjustment of functional- and psychological-covariates, participants were, respectively, 1.6 times and 1.4 times more likely to experience oral impacts. CONCLUSION: This study revealed that early tooth loss at age 50 was independently associated with subsequent impaired OHRQoL at ages 65, 70 and 75. The aspects of behavioural- and age-related factors in terms of disadvantages in functional and psychological concerns seemed to play a role in explaining the long-term impact of tooth loss on impaired OHRQoL. A mid-life approach to the prevention of tooth loss for the protection of subsequent adverse health outcomes should guide health promotion interventions and also be recognized by oral health care providers both for patient interaction and clinical decision making.

Exploring avoidance of dental care due to dental fear and economic burden -A cross-sectional study in a national sample of younger adults in Norway.

AIM: To assess the prevalence of dental avoidance due to dental fear and economic burden and its distribution by utilization of dental care and socio-behavioural characteristics. METHOD: A sample of 9052 Norwegian adults aged 25-35 years was invited to participate, and 2551 completed electronic questionnaires regarding lifetime prevalence of dental avoidance due to fear and last year prevalence of dental avoidance due to economic burden. RESULTS: Cancelled- and avoided ordering appointments due to fear amounted to 14.7% and 30.5%, respectively. Avoidance of dental visits due to cost was 37.7%. Frequency of cancelled appointments due to fear was 30% and 16.6% among participants attending dental care several times annually and seldom, respectively. Multiple logistic regression revealed that avoiding dental visits due to cost was less likely among participants with higher household income (OR 0.4, 95% CI 0.3-0.5) and more likely among participants with dental care need (OR 1.8, 95% CI 1.2-2.7). Cancelled and avoided appointments due to fear was most likely among those with need for dental care and lower education. Early unpleasant experience with dental care remained a covariate of avoidance behaviour due to fear. CONCLUSION: 14.7%, 30.5%, and 37.7% confirmed cancelled appointments due to fear, avoided ordering appointments due to fear, and avoided visiting the dentist due to cost. Avoiding dental care due to fear and economic burden was more and less common among participants with respectively, frequent and seldom use of dental care. Dental avoidance behaviours were highest among socially disadvantaged groups, indicating a hole in the welfare state model that needs political consideration.

Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study.

BACKGROUND: Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. METHODS: This multi-center, cross-sectional study, included individuals with JIA aged 4-16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education. RESULTS: Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43-5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10-5.01). No associations were found with active JIA disease or more severe disease characteristics. CONCLUSION: In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health.

Association of oral bacteria with oral hygiene habits and self-reported gingival bleeding.

AIM: To describe associations of gingival bacterial composition and diversity with self-reported gingival bleeding and oral hygiene habits in a Norwegian regional-based population. MATERIALS AND METHODS: We examined the microbiome composition of the gingival fluid (16S amplicon sequencing) in 484 adult participants (47% females; median age 28 years) in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study in Bergen, Norway. We explored bacterial diversity and abundance differences by the community periodontal index score, self-reported frequency of gingival bleeding, and oral hygiene habits. RESULTS: Gingival bacterial diversity increased with increasing frequency of self-reported gingival bleeding, with higher Shannon diversity index for "always" ß = 0.51 and "often" ß = 0.75 (p < .001) compared to "never" gingival bleeding. Frequent gingival bleeding was associated with higher abundance of several bacteria such as Porphyromonas endodontalis, Treponema denticola, and Fretibacterium spp., but lower abundance of bacteria within the gram-positive phyla Firmicutes and Actinobacteria. Flossing and rinsing with mouthwash twice daily were associated with higher total abundance of bacteria in the Proteobacteria phylum but with lower bacterial diversity compared to those who never flossed or never used mouthwash. CONCLUSIONS: A high frequency of self-reported gingival bleeding was associated with higher bacterial diversity than found in participants reporting no gingival bleeding and with higher total abundance of known periodontal pathogens such as Porphyromonas spp., Treponema spp., and Bacteroides spp.

Facilitators for use of oral healthcare services among people with substance use disorders: a qualitative study in Norway.

OBJECTIVE: Opioid maintenance treatment (OMT) patients in Norway are eligible for free oral healthcare services; however, oral health morbidity remains high and the uptake of services among this patient group is low. As knowledge of the reasons for the low uptake of services among OMT patients is insufficient, this study adopted a qualitative approach to explore this from the perspectives of patients and dental healthcare workers (DHWs). MATERIAL AND METHODS: Through focus group and individual interviews, data were collected from 63 participants: 30 patients receiving OMT and 33 DHWs. Key themes were identified through a thematic analysis. RESULTS: Teeth were a significant factor in OMT patients' quality of life and recovery. Accompaniment to scheduled dentist appointments was identified as a facilitator by both the patients and the DHWs. The dentist-patient relationship was also seen as an important facilitator of dental treatment; DHWs with previous experience of treating OMT patients were valued by patients because of their high verbal and non-verbal communication. CONCLUSIONS: Helping OMT patients attend dental appointments, improving the dentist-patient relationship, and expanding stakeholders' knowledge of OMT patients' right to oral healthcare services may increase the uptake and benefits of dental healthcare services among OMT patients. The current support framework within the OMT system has the potential to increase the communication and efficiency of dental healthcare services available to patients undergoing OMT.

Dental health personnel's experience with receiving inquiries from child welfare services: a national cross-sectional study.

OBJECTIVES: To assess if and to what extent public dental health personnel (PDHP) receive inquiries from child welfare services (CWS), and to assess whether PDHP's experience of receiving inquiries is associated with PDHP's characteristics and whether the associations are influenced by PDHP's experience of reporting to CWS. MATERIAL AND METHODS: Questionnaires were distributed to 1542 PDHP in Norway. Descriptive statistics were used for analysis. Negative-binominal-regression analyses with incidence rate ratios (IRRs) and confidence intervals (CIs) were used to estimate the association between received inquiries from CWS and PDHP characteristics. RESULTS: From a total of 1074 respondents, 52.4% had received inquiries from CWS (2012-2014) with a mean number of 3.9 (SD = 4.5). PDHP's likelihood of receiving inquiries was significantly associated with having many patients, working in small municipalities, working in eastern Norway, having good knowledge of the Health Personnel Act, and having experience reporting to CWS. Regional differences were the only association that varied according to PDHP reporting activity. CONCLUSIONS: PDHP receive inquiries from the CWS. The likelihood of receiving inquiries is associated with several characteristics of PDHP. To increase PDHP's likelihood of receiving inquiries, it is important to establish contact between the CWS and PDHS and ensure that the PDHP has good knowledge of the Health Personnel Act.

Reporting suspicion of child maltreatment - a 5 yr follow-up of public dental health care workers in Norway.

OBJECTIVE: This study examined stability and change of Norwegian dental health care workers' mandated reporting of suspected child maltreatment from 2014 to 2019 as well as the influence on reporting practices from regional, sociodemographic- and attitudinal factors. It was hypothesised that those factors associate independently with reporting practices across the survey period. METHODS: In 2014 a census of 1542 dental health care workers employed in the public dental health care service (PDHS) were invited to participate in an electronic survey and 1200 (response 77.8%) consented to participation. Corresponding figures in 2019 were 1791 and 1270 (response 70.9%). Of the 1200 participants in 2014, 591 participated in 2019 (follow up 49.3%). RESULTS: A total of 58% and 25.7% of the dental health care workers confirmed ever reporting and avoidance of reporting in both survey years whereas 24.6% and 17.2% changed the status of ever- and avoiding reporting across time. The likelihood of being a stable reporter was greatest in experienced participants, those living in eastern parts of Norway and confirming professional obligations to report. At the population level, 59.6% and 79.5% confirmed ever reporting of suspected maltreatment in 2014 and 2019. Corresponding figures for confirmed avoidance of reporting were 33.9% and 37.9%. CONCLUSION: Reporting of suspected child maltreatment is maintained at a relatively high level and varies by socio-demographic and attitudinal concerns.

Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers - a multilevel analysis.

OBJECTIVES: To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. MATERIALS AND METHODS: Caries experience was recorded using the World Health Organization's Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. RESULTS: The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women's increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1-2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2-3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). CONCLUSIONS: Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status.

Oral health related quality of life and reasons for non-dental attendance among patients with substance use disorders in withdrawal rehabilitation.

No study has assessed the socio-behavioral distribution of oral health related quality of life (OHRQoL) among patients with substance use disorders receiving medically assisted rehabilitation therapy (MAR) in Norway. OBJECTIVES: To examine the prevalence of oral impacts on daily performances (OIDP) and its distribution among MAR patients in western Norway. We also examined whether oral impacts discriminate with different reasons for non-dental attendance. MATERIAL AND METHODS: A cross-sectional study focusing OHRQoL was nested to the INTRO-HCV study and implemented in six rehabilitation clinics for people with substance use disorders. A total of 167 MAR patients completed personal interviews and oral clinical examination upon entering the clinic for their MAR medication. RESULTS: The prevalence of oral impacts (OIDP > 0) was 61%. Logistic regression, adjusted for sex and age presented with odds ratios (OR) with 95% confidence intervals (CI) revealed that less than 20 remaining teeth (OR = 5.3 95% CI: 1.6-23.3) and dissatisfaction with dental care (OR = 5.1 95% CI: 1.3-19.0) increased the odds of having OIDP > 0. OIDP > 0 was also associated with insufficient dental follow-up due to dental anxiety and poor experiences with perceived attitudes of dental workers. Means OIDP among people with negative experiences with attitudes of dental care workers were 3.1 (SD 0.8) compared to 1.4 (SD 0.7) among those without negative experiences, and 2.8 (SD) for those with dental anxiety compared to 1.8 (SD) among those without. CONCLUSION: OHRQoL among MAR patients was generally poor. To reach those with a need for dental care, modification of the existing rehabilitation approach toward closer collaboration between dental health care workers and others in contact with drug users might be necessary.

Regional variations in caries experience, predictors, and follow-up among children and adolescents in Western Norway.

OBJECTIVE: To identify regional differences in, and determinants of dental caries among children in western Norway. MATERIAL AND METHODS: We studied dental caries in 705 children aged 12 years and 18 years living in the southern region (n = 403) and other parts of Hordaland County (n = 302) in Norway. Information on oral hygiene, fluoride intake, and sugar consumption was collected using questionnaires. We also collected information from the Public Dental Service (PDS) on the history of decayed, missing, or filled teeth; professional fluoride application; recall and regular check-up intervals and treatment visits. Residence (southern region versus the rest of Hordaland, the reference) was the independent variable. We analysed regional differences in (i) caries prevalence and severity, (ii) potential contributors to caries, and (iii) procedures and routines in PDS. RESULTS: Caries prevalence and severity were higher in the southern region (67% and 24%, respectively). Self-reported brushing habits, fluoride use, and sugar consumption patterns were similar between regions. We observed more frequent application of professional fluoride (incidence rate ratio [IRR] = 3.05, 95% CI: 1.99-4.66], fewer check-ups [IRR = 0.88, 95% CI: 0.81-0.95], and fewer treatment visits [IRR = 0.77, 95% CI: 0.60-0.98] among participants in the southern region, compared to the rest of Hordaland. The recall intervals in the southern region were 10% longer among 12-year-olds and 10% shorter among 18-year-olds, compared to their respective counterparts in Hordaland. CONCLUSIONS: The observed regional gradients in caries experience mirrored regional differences in dental routines and procedures. Caries-related risk behaviours did not explain the observed differences in caries experience.

Predicting intention of Norwegian dental health-care workers to use nanomaterials: An application of the augmented theory of planned behavior.

Due to the rapid development of nanotechnology and its integration into dentistry, there is a need for information on the factors influencing the decision of dental health-care workers to use nanomaterials. Based on a national survey among Norwegian dentists and dental hygienists, this study applied the theory of planned behavior (TPB), augmented with past behavior and perceived risk, to predict the intention to use dental nanomaterials in the future and to assess whether an augmented TPB model operates equivalently across professional groups. Structural equation modelling was used to assess whether the hypothesized model fits the data. Of 1792 eligible participants, 851 responded to an electronic survey. Attitudes and perceived behavioral control had the strongest effect on intention, followed by past behavior and subjective norms. Risk perceptions had an indirect effect on intention. Multigroup comparison confirmed invariance of the model across professional groups. This study supports the validity of the augmented TPB model to explain the intention of Norwegian dentists and dental hygienists to use nanomaterials. The strongest influence on intention is given by the attitudes toward nanomaterials and perceived confidence in their use. The findings of the study have implications for management of the use of nanomaterials in dentistry by policy makers.

The prevalence and socio-behavioural and clinical covariates of oral health related quality of life in Ugandan mothers with and without HIV-1.

BACKGROUND: There is limited evidence regarding oral health related quality of life of HIV positive populations in sub-Saharan Africa. Focusing HIV positive- and HIV negative Ugandan mothers, this study assessed the influence of HIV status on oral health related quality of life in terms of oral impacts on daily performances, whilst adjusting for clinical- and socio-behavioural factors. We also examined whether any association of clinical and socio-behavioural factors with oral impacts on daily performances vary according to mothers' HIV status. METHODS: This cross-sectional study used data from a trial (n = 164) and a comparison group (n = 181). The trial comprised of mothers with HIV-1 participating in the ANRS 121741-PROMISE-PEP-trial (NCT00640263) conducted between 2009 and 2013 and from the ANRS 12341-PROMISE-PEP-M&S follow-up study conducted in 2017. The comparison group comprised of HIV negative mothers recruited in 2017. Interviews and clinical oral examinations were performed. The oral health related quality of life was assessed using the oral impacts on daily performances frequency scale. Caries experience and gingival bleeding were assessed using the World Health Organization's Decayed, Missed and Filled teeth indices and community periodontal index. Logistic and negative binomial regression analyses were performed. RESULTS: 29% of HIV-1 positive and 32% among the comparison reported any oral impact on daily performance. In adjusted logistic regression analysis, HIV status was not significantly associated with oral impacts on daily performances. Mother's self-reported oral health, caries experience, gingival bleeding and oral health related quality of life of their children were independently associated with oral impacts on daily performances. Corresponding prevalence ratios and 95% confidence intervals were: 0.3 (0.2-0.6), 1.8 (1.0-3.2), 1.1 (1.0-1.1), and 2.1 (1.1-4.3). No significant interaction between HIV status and covariates were observed. CONCLUSIONS: Oral health related quality of life was substantially impaired in Ugandan mothers but did not discriminate between HIV positive and negative participants. Mothers with impaired oral health related quality of life were more likely to have dental caries and children with impaired oral health related quality of life. HIV positive and negative mothers in Uganda deserve special attention regarding their oral disease and quality of life status.

Non-financial barriers in oral health care: a qualitative study of patients receiving opioid maintenance treatment and professionals' experiences.

BACKGROUND: People with substance use disorders often have poor oral health, which can negatively impact their quality of life. Since 2005, patients receiving opioid maintenance treatment (OMT) in Norway have been eligible for free oral health care services offered through public oral health clinics. Despite a large need for oral health services amongst patients in OMT, figures suggest that the use of these services is low amongst this patient group. It has been unclear which barriers that contribute to this. This qualitative study explores the underlying barriers to the use of oral health care services amongst patients in OMT, from the perspective of the patients as well as dental health care workers (DHW). METHODS: Through a combination of focus group interviews and individual interviews, data were collected from 63 participants; 30 patients in OMT and 33 DHW. Thematic analysis identified key themes for the use (or not) of oral health care services amongst patients in OMT. RESULTS: Both individual and structural barriers prevent OMT patients from using the free oral health care services offered to them. These barriers include struggling to attend appointments, anxiety and fear of dentists, discrepancies between patients' expectations and the services offered and perceived stigma. OMT patients' lack of information regarding their rights and access to oral health services was also a barrier, as was DHWs' lack of knowledge and information of the OMT system and what they can offer patients. CONCLUSIONS: OMT patients face several barriers in accessing and using oral health care services. However, through a number of relatively simple measures, it is possible that the use of oral health services amongst OMT patients can be increased.